Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Division of Sports Medicine, Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, IL, USA.
J Shoulder Elbow Surg. 2020 Feb;29(2):235-243. doi: 10.1016/j.jse.2019.06.020. Epub 2019 Sep 5.
The purpose was to assess opioid use before and after anatomic and reverse total shoulder arthroplasty (TSA) and determine patient factors associated with prolonged postoperative opioid use.
Patients undergoing primary TSA (anatomic or reverse) were identified within the Humana database from 2007 to 2015. Patients were categorized as opioid-naive patients who did not fill a prescription prior to surgery or those who filled opioid prescriptions within 3 months preoperatively (OU); the OU cohort was subdivided into those filling opioid prescriptions within 1 month preoperatively and those filling opioid prescriptions between 1 and 3 months preoperatively. The incidence of opioid use was evaluated preoperatively and longitudinally tracked for each cohort. Multivariate analysis was used to identify factors associated with opioid use at 12 months after surgery, with statistical significance defined as P < .05.
Overall, 12,038 patients (5180 in OU cohort, 43%) underwent primary TSA during the study period. Opioid use declined after the first postoperative month; however, the incidence of opioid use was significantly higher in the OU cohort than in the opioid-naive cohort at 1 year (31.4% vs. 3.1%, P < .0001). Subgroup analysis revealed a similar decline in postoperative opioid use for anatomic and reverse TSA (P < .0001 for both). Multivariate analysis identified chronic preoperative opioid use (ie, filling an opioid prescription between 1 and 3 months prior to surgery) as the strongest risk factor for opioid use at 12 months after anatomic and reverse TSA (P < .0001).
More than 40% of patients undergoing TSA received opioid medications within 3 months before surgery. Preoperative opioid use, age younger than 65 years, and fibromyalgia were independent risk factors for opioid use 1 year following anatomic and reverse TSA. Chronic preoperative opioid use conferred the highest risk of prolonged postoperative opioid use.
目的是评估解剖型和反式全肩关节置换术（TSA）前后的阿片类药物使用情况，并确定与术后长期使用阿片类药物相关的患者因素。
在 2007 年至 2015 年期间，从 Humana 数据库中确定接受初次 TSA（解剖型或反式）的患者。将患者分为术前未开具处方的阿片类药物未使用患者或术前 3 个月内开具阿片类药物处方的患者（OU）；OU 队列进一步分为术前 1 个月内开具阿片类药物处方的患者和术前 1 至 3 个月内开具阿片类药物处方的患者。评估每个队列的术前和纵向阿片类药物使用发生率。使用多变量分析确定与术后 12 个月阿片类药物使用相关的因素，统计学意义定义为 P <.05。
总体而言，在研究期间，共有 12038 名患者（OU 队列中有 5180 名，占 43%）接受了初次 TSA。术后第一个月后，阿片类药物使用量下降；然而，OU 队列在术后 1 年的阿片类药物使用率明显高于阿片类药物未使用队列（31.4% vs. 3.1%，P <.0001）。亚组分析显示，解剖型和反式 TSA 的术后阿片类药物使用量均呈下降趋势（两者均 P <.0001）。多变量分析确定术前慢性阿片类药物使用（即在手术前 1 至 3 个月内开具阿片类药物处方）是解剖型和反式 TSA 术后 12 个月阿片类药物使用的最强危险因素（P <.0001）。
超过 40%接受 TSA 的患者在手术前 3 个月内接受了阿片类药物治疗。术前阿片类药物使用、年龄小于 65 岁和纤维肌痛是解剖型和反式 TSA 后 1 年阿片类药物使用的独立危险因素。慢性术前阿片类药物使用导致术后长期使用阿片类药物的风险最高。
